Abstract
A 63-year-old man with hypertension and 3-vessel coronary artery disease previously
treated with coronary artery bypass graft was admitted to our emergency room complaining
of chest pain. He had undergone pacemaker implant 5 months before due to paroxysmal
advanced atrioventricular block. Electrocardiography and troponin testing were unremarkable.
Echocardiography and chest X-ray ruled out lead displacement and perforation. Interrogation
showed normal parameters [right atrium: impedance 550 Ohm bipolar, sensing 2.4 mV
bipolar; threshold 0.50 V/0.4 ms bipolar; right ventricle (RV): impedance 580 Ohm
bipolar, sensing > 25 mV bipolar; threshold 1.5 V/0.4 ms bipolar and 0.4 V/0.4 ms
unipolar]. Pain was evoked only during RV pacing. An electrophysiology study demonstrated
painful RV pacing from multiple sites. We hypothesized that pain was associated with
pacing-induced dyssynchrony. His-bundle pacing (HBP) was considered as a solution.
We achieved HBP with a bipolar fixed-screw catheter connected to a cardiac resynchronization
therapy pacemaker generator. During HBP above threshold (4.00 V/1.00 ms) the patient
did not complain of any pain. He was discharged 3 days later pain-free with His-bundle
lead amplitude set at 5.00 V/1.00 ms. After 6 months the patient was asymptomatic,
with the device showing normal functioning.
This is the first clinical experience of painful RV pacing treated with HBP.
<Learning objective: Painful right ventricular pacing in the absence of perforation is a rare but potentially
underdiagnosed condition. Ventricular dyssynchrony could represent the underlying
mechanism. Physiological electromechanical activation achieved via His-bundle pacing
could represent an effective therapeutic option.>
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiology CasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Chest pain associated with moderator band pacing.Tex Heart Inst J. 2014; 41: 551-553
- Rate-related left bundle branch block as a cause of non-ischemic chest pain.Cathet Cardiovasc Diagn. 1991; 22: 45-46
- Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment.Heart Rhythm. 2016; 13: 226-232
- Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries.J Am Coll Cardiol. 1990; 16: 1359-1366
- Neural systems supporting interoceptive awareness.Nat Neurosci. 2004; 7: 189-195
- Painful left bundle branch syndrome treated successfully with permanent His bundle pacing.Heart Rhythm Case Rep. 2018; 4: 439-443
Article info
Publication history
Published online: November 21, 2021
Accepted:
November 2,
2021
Received in revised form:
October 23,
2021
Received:
March 28,
2021
Identification
Copyright
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
